CENTURION INSURANCE

Due to the Coronavirus, our office will be operating remotely in order to
keep our staff free from infection. For latest update on the virus as it pertains to
Florida please access our link. Office: 813.995.6013 Ext: 101 / Direct: 727.755.3060
Email: info@centurioninsuranceafs.com

Commercial Auto Quote

Please complete the details below in order to obtain your Quote. We will have a Personal Protection Specialist contact you. 











    NoneICCDMVOtherN/A


    Intrastate (CA only)0-100 MILES101-200 MILES201-300 MILES301-500 MILESIntrastate-Exactly where?N/A

    Driver Information






























    *Specify the number of year’s commercial driving experience each driver has. If there are any drivers with a “not at fault” accident, please provide a copy of the policy report with your submission

    Vehicle / Equipment:

    Vehicle / Equipment 1






    Vehicle / Equipment 2






    Vehicle / Equipment 3






    Vehicle / Equipment 4






    *If there are 5 or more power units, please provide a completed ACORD or completed company application instead of this form for quoting.

    TRAILER(S):

    TRAILER(T1)







    "If additional Trailers please add information in Comments Box at the end the form".

    *Please specify if applicant is pulling non-owned trailers and if applicant is pulling doubles.

    COVERAGES:


    $100K CSL$300K CSL$500K CSL$750K CSL$1M CSL$500AUTO LIABILITY DEDUCTIBLE:OTHERN/A


    $15,000/$30,000$25,000/$50,000$30,000/$60,000CARGO$25,000$50,000DEDUCTIBLEN/A


    DEDUCTIBLE:

    PRIOR INSURANCE HISTORY FOR THE PAST 3 YEARS:

    POLICY PERIOD



    LIABILITY LOSSES



    LOSSES



    *If any prior losses, please provide a copy of currently valued loss runs.


    Your Information is Secure

    Insurance coverage cannot be bound or changed via submission of this online form/application, e-mail, voice mail or facsimile. No binder, insurance policy, change, addition, and/or deletion to insurance coverage goes into effect unless and until confirmed directly with a licensed agent.

    Note any proposal of insurance we may present to you will be based upon the values developed and exposures to loss disclosed to us on this online form/application and/or in communications with us. All coverages are subject to the terms, conditions and exclusions of the actual policy issued. Not all policies or coverages are available in every state. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not distribute to other parties.